Provider Demographics
NPI:1073090403
Name:PARKER, LATONIA D
Entity Type:Individual
Prefix:
First Name:LATONIA
Middle Name:D
Last Name:PARKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 FOX MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:CAHOKIA
Mailing Address - State:IL
Mailing Address - Zip Code:62206-2503
Mailing Address - Country:US
Mailing Address - Phone:314-590-3493
Mailing Address - Fax:
Practice Address - Street 1:20 FOX MEADOW LN
Practice Address - Street 2:
Practice Address - City:CAHOKIA
Practice Address - State:IL
Practice Address - Zip Code:62206-2503
Practice Address - Country:US
Practice Address - Phone:314-590-3493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-27
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)